Wk 8 - Cognitive Analytic Therapy

Question 1

In CAT, early life interactions with others teach us about _______ ______.

Answer 1

Relational scripts

Question 2

Why was CAT developed?

Answer 2

There was a need for a short-term, evidence-based psychodynamic psychotherapy.

Question 3

CAT is an integration of _____ and _____ ideas

Answer 3

cognitive

psychoanalyitc

Question 4

What are the 3 important insights of psychoanalysis?

Answer 4

1) Impact of early relationship patterns - repeated in your life
2) Relationship patterns are at the root of psychological disorders
3) Relationship patterns are expected to repeat in the therapist-client relationship and modified from there

Question 5

Describe the Procedural Sequence Model. (7 steps)

Answer 5

1) define aim in the situation
2) appraise if aim is aligned to personal values
3) evaluate personal ability and outcome of achieving the aim
4) select best method/role available
5) act on chosen method/role in relationship
6) evaluate effectiveness
7) confirm/revise role

Question 6

What is Reciprocal Role Procedures (RRP)?

Answer 6

Procedure of predicting or seeking certain social outcomes. (eg. acknowledgement and reciprocation from others)

Question 7

Describe how reciprocal relationship roles are learnt.

Answer 7

Based on early relationships with our parents/caretakers, we take on particular roles. We act based on certain scripts associated with that role. We also learn and internalize the opposite role. These roles we learnt in the past are repeated throughout our lives. When one role is too painful to experience, the person may consistently choose to take on the opposite role.

Question 8

Name 5 common reciprocal patterns.

Answer 8

1) ideal caregiver - ideally cared for
2) over-involved - over dependent
3) unreliable - needy
4) conditional acceptance - striving, performing
5) controlling - deprived/guilty/rebellious
6) abusive - abused/angry

Question 9

What are the 3 key ideas of CAT?

Answer 9

1) dilemmas
2) traps
3) snags

Question 10

Describe what are dilemmas.

Answer 10

False dichotomy or forced choice where client only assumes 2 possible polarized options. Taking either of the extreme positions are problematic. They tend to take on an “Either … Or …” phrasing.

Question 11

Give an example of a common dilemma.

Answer 11

Either I give in, or I will be very demanding.
If I give in consistently, I will feel out of control, and my needs will be ignored. I will then break off the relationship.
If I am too demanding, others needs will be ignored and will not want this relationship with me.
Others
- I look down on people/others look down on me
- i spoil myself and be greedy/i dent my self things
- loved entirely or not at all

Question 12

What are traps?

Answer 12

Traps are like vicious cycles we see in CBT. Its like a self- perpetuating and self-fulfilling prophecy. Have negative beliefs which leads to rigid behaviors. This rigid behaviors create a negative consequence, which then confirms initial negative beliefs. (basically just behave in a way that reinforces the belief)

Question 13

What are snags?

Answer 13

When personal goals are abandoned or sabotaged because of the expectation that it is dangerous or not allowed. It seems like self-sabotaging that is done out of the blue.

Question 14

Why do people engage in snag behavior? (3)

Answer 14

1) they feel like they don’t deserve it
2) it deprives others and there are not enough good things to go around
3) others may envy them

Question 15

According to CAT, what are health people like and what are dysfunctional people like?

Answer 15

Healthy people

• internalize a range of adaptive reciprocal roles
• able to use them to make somewhat accurate predictions of how others would react
• act in adaptive ways in relationships

Question 16

What is the assessment like in CAT?

Answer 16

1) read referral letter and other clinical files
2) clients invited to tell their story
3) problem procedure in therapist-client relationship should be noted
4) reformulations done collaboratively. therapist’s job is to bring insight and understanding to the client’s situation, propose these ideas to client, and see if it fits with their experiences.

Question 17

What is the process of CAT? (6)

Answer 17

1) target problems identified
2) agree on problematic procedural sequence (dilemma, traps, snags, reciprocal roles)
3) coherent narrative on how they are developed
4) reformulation letter is written
5) revise problematic procedures (finding possible exits)
6) goodbye letter

Question 18

How do you revise problematic procedures?

Answer 18

1) think of new healthier ways of relating to others
2) address underlying unmet needs (eg. self-care)
3) draw on client’s strengths and coping abilities
4) Exits must be realistic and suggestions may be offered by the therapist.

Question 19

What are the 4 different techniques used in CAT?

Answer 19

1) psychotherapy file
2) diary thoughts and mood
3) reformulation letter. sequential diagrammatic reformulation (SDR)
4) goodbye letters

Question 20

Describe the technique of using a psychotherapy file.

Answer 20

It’s an information handout with a list of dilemmas, traps, and snags where clients are able to recognize problematic procedures in the form and see if it is applicable in their lives.
Goals:
- increases self-reflection.
- normalizes their experiences as clients realise that their experiences are not unique to them.

Question 21

Describe the technique of a reformulation letter.

Answer 21

the letter is addressed to the client. the letter …

1) summarises the key events of the past
2) explains in a non-blaming way how the negative patterns of the past are repeating. explains how the key dilemmas, traps, and snags are linked to the client’s reciprocal roles
3) Sequential Diagrammatic Reformulation (SDR) put into a diagram so it’s easier for clients to see the pattern. put down possible exit points.

Question 22

Describe what goodbye letters are like.

Answer 22

accurate rather than optimistic description of what has and has not been achieved. make sure that therapist and therapy is not idealized. areas for further work is highlighted.